Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya
Identifieur interne : 001641 ( Pmc/Corpus ); précédent : 001640; suivant : 001642Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya
Auteurs : Vincent Ochieng-Ooko ; Daniel Ochieng ; John E. Sidle ; Margaret Holdsworth ; Kara Wools-Kaloustian ; Abraham M Siika ; Constantin T. Yiannoutsos ; Michael Owiti ; Sylvester Kimaiyo ; Paula BraitsteinSource :
- Bulletin of the World Health Organization [ 0042-9686 ] ; 2010.
Abstract
To determine the incidence of loss to follow-up in a treatment programme for people living with human immunodeficiency virus (HIV) infection in Kenya and to investigate how loss to follow-up is affected by gender.
Between November 2001 and November 2007, 50 275 HIV-positive individuals aged ≥ 14 years (69% female; median age: 36.2 years) were enrolled in the study. An individual was lost to follow-up when absent from the HIV treatment clinic for > 3 months if on combination antiretroviral therapy (cART) or for > 6 months if not. The incidence of loss to follow-up was calculated using Kaplan–Meier methods and factors associated with loss to follow-up were identified by logistic and Cox multivariate regression analysis.
Overall, 8% of individuals attended no follow-up visits, and 54% of them were lost to follow-up. The overall incidence of loss to follow-up was 25.1 per 100 person–years. Among the 92% who attended at least one follow-up visit, the incidence of loss to follow-up before and after starting cART was 27.2 and 14.0 per 100 person–years, respectively. Baseline factors associated with loss to follow-up included younger age, a long travel time to the clinic, patient disclosure of positive HIV status, high CD4+ lymphocyte count, advanced-stage HIV disease, and rural clinic location. Men were at an increased risk overall and before and after starting cART.
The risk of being lost to follow-up was high, particularly before starting cART. Men were more likely to become lost to follow-up, even after adjusting for baseline sociodemographic and clinical characteristics. Interventions designed for men and women separately could improve retention.
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DOI: 10.2471/BLT.09.064329
PubMed: 20865073
PubMed Central: 2930357
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya</title><author><name sortKey="Ochieng Ooko, Vincent" sort="Ochieng Ooko, Vincent" uniqKey="Ochieng Ooko V" first="Vincent" last="Ochieng-Ooko">Vincent Ochieng-Ooko</name><affiliation><nlm:aff id="aff1">United States Agency for International Development, Academic Model Providing Access To Healthcare Partnership, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Ochieng, Daniel" sort="Ochieng, Daniel" uniqKey="Ochieng D" first="Daniel" last="Ochieng">Daniel Ochieng</name><affiliation><nlm:aff id="aff1">United States Agency for International Development, Academic Model Providing Access To Healthcare Partnership, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Sidle, John E" sort="Sidle, John E" uniqKey="Sidle J" first="John E" last="Sidle">John E. Sidle</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Holdsworth, Margaret" sort="Holdsworth, Margaret" uniqKey="Holdsworth M" first="Margaret" last="Holdsworth">Margaret Holdsworth</name><affiliation><nlm:aff id="aff1">United States Agency for International Development, Academic Model Providing Access To Healthcare Partnership, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Wools Kaloustian, Kara" sort="Wools Kaloustian, Kara" uniqKey="Wools Kaloustian K" first="Kara" last="Wools-Kaloustian">Kara Wools-Kaloustian</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Siika, Abraham M" sort="Siika, Abraham M" uniqKey="Siika A" first="Abraham M" last="Siika">Abraham M Siika</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Yiannoutsos, Constantin T" sort="Yiannoutsos, Constantin T" uniqKey="Yiannoutsos C" first="Constantin T" last="Yiannoutsos">Constantin T. Yiannoutsos</name><affiliation><nlm:aff id="aff4">Department of Biostatistics, Indiana University, Indianapolis,<country>USA</country>.</nlm:aff></affiliation></author><author><name sortKey="Owiti, Michael" sort="Owiti, Michael" uniqKey="Owiti M" first="Michael" last="Owiti">Michael Owiti</name><affiliation><nlm:aff id="aff3">School of Medicine, Moi University, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Kimaiyo, Sylvester" sort="Kimaiyo, Sylvester" uniqKey="Kimaiyo S" first="Sylvester" last="Kimaiyo">Sylvester Kimaiyo</name><affiliation><nlm:aff id="aff3">School of Medicine, Moi University, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Braitstein, Paula" sort="Braitstein, Paula" uniqKey="Braitstein P" first="Paula" last="Braitstein">Paula Braitstein</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20865073</idno><idno type="pmc">2930357</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930357</idno><idno type="RBID">PMC:2930357</idno><idno type="doi">10.2471/BLT.09.064329</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">001641</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001641</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya</title><author><name sortKey="Ochieng Ooko, Vincent" sort="Ochieng Ooko, Vincent" uniqKey="Ochieng Ooko V" first="Vincent" last="Ochieng-Ooko">Vincent Ochieng-Ooko</name><affiliation><nlm:aff id="aff1">United States Agency for International Development, Academic Model Providing Access To Healthcare Partnership, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Ochieng, Daniel" sort="Ochieng, Daniel" uniqKey="Ochieng D" first="Daniel" last="Ochieng">Daniel Ochieng</name><affiliation><nlm:aff id="aff1">United States Agency for International Development, Academic Model Providing Access To Healthcare Partnership, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Sidle, John E" sort="Sidle, John E" uniqKey="Sidle J" first="John E" last="Sidle">John E. Sidle</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Holdsworth, Margaret" sort="Holdsworth, Margaret" uniqKey="Holdsworth M" first="Margaret" last="Holdsworth">Margaret Holdsworth</name><affiliation><nlm:aff id="aff1">United States Agency for International Development, Academic Model Providing Access To Healthcare Partnership, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Wools Kaloustian, Kara" sort="Wools Kaloustian, Kara" uniqKey="Wools Kaloustian K" first="Kara" last="Wools-Kaloustian">Kara Wools-Kaloustian</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Siika, Abraham M" sort="Siika, Abraham M" uniqKey="Siika A" first="Abraham M" last="Siika">Abraham M Siika</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Yiannoutsos, Constantin T" sort="Yiannoutsos, Constantin T" uniqKey="Yiannoutsos C" first="Constantin T" last="Yiannoutsos">Constantin T. Yiannoutsos</name><affiliation><nlm:aff id="aff4">Department of Biostatistics, Indiana University, Indianapolis,<country>USA</country>.</nlm:aff></affiliation></author><author><name sortKey="Owiti, Michael" sort="Owiti, Michael" uniqKey="Owiti M" first="Michael" last="Owiti">Michael Owiti</name><affiliation><nlm:aff id="aff3">School of Medicine, Moi University, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Kimaiyo, Sylvester" sort="Kimaiyo, Sylvester" uniqKey="Kimaiyo S" first="Sylvester" last="Kimaiyo">Sylvester Kimaiyo</name><affiliation><nlm:aff id="aff3">School of Medicine, Moi University, Eldoret,<country>Kenya</country>.</nlm:aff></affiliation></author><author><name sortKey="Braitstein, Paula" sort="Braitstein, Paula" uniqKey="Braitstein P" first="Paula" last="Braitstein">Paula Braitstein</name><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</nlm:aff></affiliation></author></analytic><series><title level="j">Bulletin of the World Health Organization</title><idno type="ISSN">0042-9686</idno><idno type="eISSN">1564-0604</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec><title>Objective</title><p>To determine the incidence of loss to follow-up in a treatment programme for people living with human immunodeficiency virus (HIV) infection in Kenya and to investigate how loss to follow-up is affected by gender.</p></sec><sec><title>Methods</title><p>Between November 2001 and November 2007, 50 275 HIV-positive individuals aged ≥ 14 years (69% female; median age: 36.2 years) were enrolled in the study. An individual was lost to follow-up when absent from the HIV treatment clinic for > 3 months if on combination antiretroviral therapy (cART) or for > 6 months if not. The incidence of loss to follow-up was calculated using Kaplan–Meier methods and factors associated with loss to follow-up were identified by logistic and Cox multivariate regression analysis.</p></sec><sec><title>Findings</title><p>Overall, 8% of individuals attended no follow-up visits, and 54% of them were lost to follow-up. The overall incidence of loss to follow-up was 25.1 per 100 person–years. Among the 92% who attended at least one follow-up visit, the incidence of loss to follow-up before and after starting cART was 27.2 and 14.0 per 100 person–years, respectively. Baseline factors associated with loss to follow-up included younger age, a long travel time to the clinic, patient disclosure of positive HIV status, high CD4+ lymphocyte count, advanced-stage HIV disease, and rural clinic location. Men were at an increased risk overall and before and after starting cART.</p></sec><sec><title>Conclusion</title><p>The risk of being lost to follow-up was high, particularly before starting cART. Men were more likely to become lost to follow-up, even after adjusting for baseline sociodemographic and clinical characteristics. Interventions designed for men and women separately could improve retention.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Bull World Health Organ</journal-id><journal-id journal-id-type="publisher-id">BLT</journal-id><journal-title-group><journal-title>Bulletin of the World Health Organization</journal-title></journal-title-group><issn pub-type="ppub">0042-9686</issn><issn pub-type="epub">1564-0604</issn><publisher><publisher-name>World Health Organization</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20865073</article-id><article-id pub-id-type="pmc">2930357</article-id><article-id pub-id-type="publisher-id">BLT.09.064329</article-id><article-id pub-id-type="doi">10.2471/BLT.09.064329</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya</article-title><trans-title-group xml:lang="ar"><trans-title>تأثير نوع الجنس على فقدان متابعة الحالات في برنامج علاجي موسع لفيروس الإيدز في غربي كينيا</trans-title></trans-title-group><trans-title-group xml:lang="fr"><trans-title>Influence du sexe de la personne sur la perte du suivi dans un vaste programme de traitement du VIH dans l’ouest du Kenya </trans-title></trans-title-group><trans-title-group xml:lang="es"><trans-title>Influencia del género en las bajas en el seguimiento de un amplio programa terapéutico contra el VIH en el oeste de Kenya</trans-title></trans-title-group><alt-title alt-title-type="author-running-head">Vincent Ochieng-Ooko et al.</alt-title><alt-title alt-title-type="title-running-head">Gender and loss to follow-up of HIV patients in Kenya</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ochieng-Ooko</surname><given-names>Vincent</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ochieng</surname><given-names>Daniel</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sidle</surname><given-names>John E</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Holdsworth</surname><given-names>Margaret</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wools-Kaloustian</surname><given-names>Kara</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Siika</surname><given-names>Abraham M</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yiannoutsos</surname><given-names>Constantin T</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Owiti</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kimaiyo</surname><given-names>Sylvester</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Braitstein</surname><given-names>Paula</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><aff id="aff1"><label>a</label>United States Agency for International Development, Academic Model Providing Access To Healthcare Partnership, Eldoret,<country>Kenya</country>.</aff><aff id="aff2"><label>b</label>Indiana University School of Medicine, 1001 West 10th Street (OPW-M200), Indianapolis, IN, 46202,<country>United States of America</country>.</aff><aff id="aff3"><label>c</label>School of Medicine, Moi University, Eldoret,<country>Kenya</country>.</aff><aff id="aff4"><label>d</label>Department of Biostatistics, Indiana University, Indianapolis,<country>USA</country>.</aff></contrib-group><author-notes><corresp id="cor1">Correspondence to Paula Braitstein (e-mail: <email xlink:href="pbraitstein@yahoo.com">pbraitstein@yahoo.com</email>).</corresp></author-notes><pub-date pub-type="ppub"><day>01</day><month>9</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>16</day><month>4</month><year>2010</year></pub-date><volume>88</volume><issue>9</issue><fpage>681</fpage><lpage>688</lpage><history><date date-type="received"><day>20</day><month>10</month><year>2009</year></date><date date-type="rev-recd"><day>13</day><month>1</month><year>2010</year></date><date date-type="accepted"><day>18</day><month>1</month><year>2010</year></date></history><permissions><copyright-statement>(c) World Health Organization (WHO) 2010. All rights reserved.</copyright-statement><copyright-year>2010</copyright-year></permissions><abstract><title>Abstract</title><sec><title>Objective</title><p>To determine the incidence of loss to follow-up in a treatment programme for people living with human immunodeficiency virus (HIV) infection in Kenya and to investigate how loss to follow-up is affected by gender.</p></sec><sec><title>Methods</title><p>Between November 2001 and November 2007, 50 275 HIV-positive individuals aged ≥ 14 years (69% female; median age: 36.2 years) were enrolled in the study. An individual was lost to follow-up when absent from the HIV treatment clinic for > 3 months if on combination antiretroviral therapy (cART) or for > 6 months if not. The incidence of loss to follow-up was calculated using Kaplan–Meier methods and factors associated with loss to follow-up were identified by logistic and Cox multivariate regression analysis.</p></sec><sec><title>Findings</title><p>Overall, 8% of individuals attended no follow-up visits, and 54% of them were lost to follow-up. The overall incidence of loss to follow-up was 25.1 per 100 person–years. Among the 92% who attended at least one follow-up visit, the incidence of loss to follow-up before and after starting cART was 27.2 and 14.0 per 100 person–years, respectively. Baseline factors associated with loss to follow-up included younger age, a long travel time to the clinic, patient disclosure of positive HIV status, high CD4+ lymphocyte count, advanced-stage HIV disease, and rural clinic location. Men were at an increased risk overall and before and after starting cART.</p></sec><sec><title>Conclusion</title><p>The risk of being lost to follow-up was high, particularly before starting cART. Men were more likely to become lost to follow-up, even after adjusting for baseline sociodemographic and clinical characteristics. Interventions designed for men and women separately could improve retention.</p></sec></abstract><trans-abstract xml:lang="ar"><title>ملخص</title><sec><title>الغرض</title><p>تحديد معدل وقوع فقدان متابعة الحالات في برنامج علاجي للمعايشين لفيروس الإيدز في كينيا وتقصي كيف يتأثر فقدان متابعة الحالات بنوع الجنس.</p></sec><sec><title>الطريقة</title><p>في الفترة بين تشرين الثاني/نوفمبر 2001 حتى تشرين الثاني/نوفمبر 2007، أدرج في الدراسة 50275 شخصاً إيجابياً لفيروس الإيدز عمرهم أكبر من أو يساوي 14 سنة (شكلت الإناث 69% منهم؛ والمتوسط العمري لديهم كان: 36.2 سنة). واعتبر أن الشخص قد فقد المتابعة إذا تغيب عن عيادة العلاج لأكثر من 3 شهور إذا كان يعالج بمزيج من مضادات الفيروسات القهقرية أو إذا غاب أكثر من 6 شهور ولم يكن يعالج. وحُسِبَ معدل وقوع فقدان المتابعة باستخدام طرق كابلان-مايير Kaplan–Meier، وحددت العوامل المرتبطة بفقدان متابعة الحالات عن طريق التحليل اللوجستي وتحليل كوكس للتحوف المتعدد المتغيرات.</p></sec><sec><title>الموجودات</title><p>إجمالياً، حضر 8% من الأفراد زيارات بدون متابعة، وفقد منهم 54% في المتابعة. وكان إجمالي معدل وقوع فقدان المتابعة للحالات هو 25.1 لكل 100 شخص سنوياً. ومن بين 92% من الذين حضروا زيارة متابعة واحدة على الأقل، كان معدل وقوع فقدان المتابعة قبل وبعد بدء المعالجة بمزيج من مضادات الفيروسات القهقرية 27.2 و 14.0 لكل 100 شخص سنوياً بالترتيب. وتضمنت العوامل القاعدية المرتبطة بفقدان المتابعة: صغر العمر، وطول مسافة الانتقال أو السفر إلى العيادة، وإفصاح المريض عن إصابته بفيروس الإيدز، والعدد المرتفع للخلايا اللمفاوية CD4+، والمرحلة المتقدمة من المرض بفيروس الإيدز، وموقع العيادة الريفية. وكان الرجال في الإجمال أكثر عرضة للخطر قبل وبعد بدء العلاج بمزيج من مضادات الفيروسات القهقرية.</p></sec><sec><title>الاستنتاج</title><p>إن خطر فقدان متابعة الحالات مرتفع، ولاسيما قبل بدء العلاج بمزيج من مضادات الفيروسات القهقرية. والأكثر ترجيحاً هو فقدان متابعة الرجال، وحتى بعد تصحيح الصفات القاعدية الاجتماعية والديموغرافية والسريرية . ويمكن للتدخلات المصممة للرجال والنساء على انفراد أن تحسّن من بقاء المرضى قيد المتابعة.</p></sec></trans-abstract><trans-abstract xml:lang="fr"><title>Résumé </title><sec><title>Objectif</title><p>Déterminer l'incidence de perte de suivi dans un programme de traitement pour les personnes vivant avec l’infection par le virus de l'immunodéficience humaine (VIH) au Kenya, et investiguer comment la perte de suivi est influencée par le sexe. </p></sec><sec><title>Méthodes</title><p>Entre novembre 2001 et novembre 2007, 50 275 individus séropositifs d’âge ≥ 14 ans (69% de sexe féminin; âge médian: 36,2 ans) ont participé à l'étude. Le suivi a été perdu lorsque les individus ont été absents de la clinique de traitement du VIH pendant > 3 mois lorsqu’ils étaient sous combinaison thérapeutique antirétrovirale (TARV), et pendant > 6 mois dans le cas contraire. L'incidence de perte du suivi a été calculée au moyen des méthodes Kaplan-Meier, et les facteurs associés à la perte du suivi ont été identifiés par la régression logistique et l’analyse multivariable par régression du modèle de Cox. </p></sec><sec><title>Conclusions</title><p>Globalement, 8% des individus ne se sont jamais présentés à une visite de suivi, et 54% d'entre eux ont perdu le suivi. L'incidence totale de perte du suivi était de 25,1 par 100 personnes-années. Parmi les 92% qui ont assisté à une visite de suivi au moins, l'incidence de perte du suivi avant et après le début du TARV a été de 27,2 et 14,0 par 100 personnes-années, respectivement. Parmi les facteurs de la ligne de base associés à la perte du suivi, ont été constatés le jeune âge, la longueur du temps de trajet pour se rendre à la clinique, la révélation de l'état VIH positif du patient, un nombre élevé de lymphocytes CD4+, un stade avancé de la maladie à VIH et la ruralité de la clinique. Les hommes ont présenté un risque plus élevé en général et ce, avant et après le début du TARV. </p></sec><sec><title>Conclusion</title><p>Le risque de perte du suivi a été élevé, particulièrement avant le début du TARV. Les hommes ont été plus enclins à perdre le suivi, même après ajustement pour base sociodémographique et caractéristiques cliniques. Des interventions conçues séparément pour les hommes et les femmes pourraient améliorer la rétention.</p></sec></trans-abstract><trans-abstract xml:lang="es"><title>Resumen</title><sec><title>Objetivo</title><p>Determinar la incidencia de bajas en el seguimiento de un programa terapéutico de personas portadoras del virus de la inmunodeficiencia humana (VIH) en Kenya, e investigar si el sexo de dichas personas influye en las bajas en el seguimiento.</p></sec><sec><title>Métodos</title><p>Entre noviembre de 2001 y noviembre de 2007 se inscribieron en el estudio 50 275 personas VIH-positivas de más de 14 años de edad (69% mujeres; edad media: 36,2 años). Se consideró una baja en el seguimiento cuando la persona se ausentó de la clínica de tratamiento del VIH durante más de tres meses si estaba en tratamiento antirretroviral combinado (TARC) o, en el caso contrario, durante más de seis meses. La incidencia de bajas en el seguimiento se ha calculado utilizando los métodos de Kaplan-Meier, y los factores asociados con las bajas en el seguimiento se han identificado mediante un análisis de regresión logística y de regresión multifactorial de Cox.</p></sec><sec><title>Resultados</title><p>En términos generales, el 8% de las personas no acudieron a las visitas de seguimiento, de las que el 54% se consideraron como bajas en el seguimiento. La incidencia total de bajas en el seguimiento fue de 25,1 por 100 años-persona. Del 92% que acudió al menos a una visita de seguimiento, la incidencia de baja en el seguimiento, antes y después de comenzar el TARC fue de 27,2 y 14,0 por 100 años persona, respectivamente. Los factores iniciales asociados a la baja en el seguimiento incluyeron: la juventud, la lejanía de la clínica, la revelación del paciente de su estado de VIH-positivo, el recuento linfocítico CD4+ elevado, enfermedades debidas al VIH en fase avanzada y la ubicación de la clínica rural. El riesgo general en hombres fue elevado, antes y después de iniciar el TARC.</p></sec><sec><title>Conclusión</title><p>El riesgo de baja en el seguimiento del paciente fue elevado, sobre todo antes de iniciar el TARC. Hubo una tendencia de más bajas en el seguimiento entre los hombres, aún después del ajuste de las características sociodemográficas y clínicas iniciales. Las intervenciones específicas e individuales para hombres y mujeres podrían mejorar la permanencia en el programa.</p></sec></trans-abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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